Remifentanil ile Kas Gevşeticisiz Entübasyon Uygulanan Çocuklarda Total İntravenöz Anestezi ile İnhaler Anestezisinin Karşılaştırılması

Yıl 2024, Cilt: 9 Sayı: 3, 323 - 329, 04.10.2024

Recep Gökçe , Sedat Hakimoğlu

https://doi.org/10.61399/ikcusbfd.1278806

Öz

Amaç: Çocuklarda tonsillektomi ve/veya adenoidektomi için remifentanil ile kas gevşeticisiz entübasyonun yanı sıra total intravenöz anestezi ile inhaler anestezinin etkileri karşılaştırılmıştır.

Gereç ve Yöntem: Aralık 2014-Haziran 2015 tarihleri arasında tonsillektomi ve/veya adenoidektomi operasyonu geçirecek 80 hasta üzerinde gerçekleştirilmiştir. Hastalar randomize edilerek iki gruba ayrılmıştır. Total intravenöz aneztezi grubuna, 2,5 mg/kg propofol ve 2 mcg/kg remifentanil 90 saniye içinde indüksiyon olarak uygulanmıştır. Bu grupta, anestezi idamesi için 3 mg/kg/saat propofol ve 0,5 mcg/kg/dk remifentanil kullanılmıştır. Sevofluran grubuna ise %8 sevofluran ve 2 mcg/kg remifentanil 90 saniye içinde indüksiyon olarak uygulanmıştır. Bu grupta, anestezi idamesi için %2,5 sevofluran, %50 azot protoksit ve %50 oksijen 6lt/dk'dan kullanılmıştır.

Bulgular: Kalp tepe atımı ve sistolik arter basıncı Grup 2'de anlamlı olarak yüksek bulunmuştur. Diyastolik arter basıncı ise Grup T'de entübasyon sonrası 1 ve 2. dakikalarda, postoperatif 10. dakikada ise Grup I'de yüksek bulunmuştur. Ortalama arter basıncı ise entübasyon sonrası 2. dakikada Grup T'de yüksek görülmüştür. Ayrıca, Wong-Baker ağrı skalası ve ajitasyon skoru Grup I'de anlamlı olarak yüksek bulunmuştur. Spontan solunuma başlama ve extübasyon zamanı ise Grup I'de anlamlı olarak kısaydı. Yan etki açısından ise gruplar arasında fark görülmemiştir.

Sonuç: Grup Total intravenöz aneztezi'nın çocuklarda daha iyi bir tercih olacağı düşünülmüştür çünkü bu yöntem postoperatif ağrı, ajitasyon ve derlenme açısından daha az etkiye sahip olmuştur.

Anahtar Kelimeler

Çocuk, İntravenöz Anestezi, Sevofluran, Derlenme, Entübasyon

Comparison of Total Intravenous Anesthesia with Inhaler Anesthesia in Children Intubated with Remifentanil without Muscle Relaxant

Öz

Objective: The effects of remifentanil and muscle relaxant-free intubation as well as total intravenous anesthesia and inhaled anesthesia for tonsillectomy and/or adenoidectomy in children were compared.

Materials and Methods: The study was conducted on 80 patients who were to undergo tonsillectomy and/or adenoidectomy between December 2014 and June 2015. Patients were randomized and divided into two groups. In the total intravenous anaesthesia group, 2.5 mg/kg propofol and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 3 mg/kg/h propofol and 0.5 mcg/kg/min remifentanil were used for maintenance of anesthesia. In the sevoflurane group, 8% sevoflurane and 2 mcg/kg remifentanil were administered as induction within 90 seconds. In this group, 2.5% sevoflurane, 50% nitrogen protoxide and 50% oxygen were used at 6 l/min for maintenance of anesthesia.

Results: Peak heart rate and systolic arterial pressure were significantly higher in Group I. Diastolic arterial pressure was significantly higher in Group T at 1 and 2 minutes after intubation and in Group 2 at 10 minutes postoperatively. Mean arterial pressure was higher in Group T at 2 minutes after intubation. In addition, Wong-Baker pain scale and agitation score were significantly higher in Group I. Spontaneous respiration and extubation time were significantly shorter in Group I. There was no difference between the groups in terms of side effects.

Conclusion: Group total intravenous anaesthesia was thought to be a better choice in children because it had less impact on postoperative pain, agitation and recovery.

Anahtar Kelimeler

Pediatric, intravenous anesthesia, sevoflurane, recovery, intubation. parents.

Kaynakça

• Erickson BK, Larson DR, Sauver JLS, Meverden RA, Orvidas LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-2005. Otolaryngol Head Neck Surg. 2009;140(6):894-901.
• Sarner JB, Levine M, Davis PJ, Lerman J, Cook RD, Motoyama EK. Clinical characteristics of sevoflurane in children: a comparison with halothane. Anesthesiology. 1995;82(1):38-46.
• Tarazi EM, Philip BK. A comparison of recovery after sevoflurane or desflurane in ambulatory anesthesia. J Clin Anesth. 1998;10(4):272-7.
• Nathanson MH, Fredman B, Smith I, White PF. Sevoflurane versus desflurane for outpatient anesthesia: a comparison of maintenance and recovery profiles. Anesth Analg. 1995;81(6):1186-90.
• Westmoreland CL, Hoke JF, Sebel PS, Hug Jr C, Muir KT. Pharmacokinetics of remifentanil (GI87084B) and its major metabolite (GI90291) in patients undergoing elective inpatient surgery. Anesthesiology. 1993;79(5):893-903.
• Eck JB, Lynn AM. Use of remifentanil in infants. Paediatr Anaesth. 1998;8(5):437-9.
• Grundmann U, Uth M, Eichner A, Wilhelm W, Larsen R. Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane‐nitrous oxide inhalation anaesthesia. Acta Anaesthesiol Scand. 1998;42(7):845-50.
• Davis PJ, Finkel JC, Orr RJ, Fazi L, Mulroy JJ, Woelfel SK, et al. A randomized, double-blinded study of remifentanil versus fentanyl for tonsillectomy and adenoidectomy surgery in pediatric ambulatory surgical patients. Anesth Analg. 2000;90(4):863-71.
• Kataria B, Epstein R, Bailey A, Schmitz M, Backus WW, Schoeck D, et al. A comparison of sevoflurane to halothane in paediatric surgical patients: results of a multicentre international study. Paediatr Anaesth. 1996;6(4):283-92.
• Jabbour-Khoury SI, Dabbous AS, Rizk LB, Abou Jalad NM, Bartelmaos TE, El-Khatib MF, et al. A combination of alfentanillidocaine- propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants. Can J Anaesth. 2003;50(2):116.
• Shields JA. Heart block and prolonged Q-Tc interval following muscle relaxant reversal: a case report. AANA J. 2008;76(1).
• Nauheimer D, Fink H, Fuchs‐Buder T, Geldner G, Hofmockel R, Ulm K, et al. Muscle relaxant use for tracheal intubation in pediatric anaesthesia: a survey of clinical practice in Germany. Paediatr Anaesth. 2009;19(3):225-31.
• Mamie C, Habre W, Delhumeau C, Barazzone Argiroffo C, Morabia A. Incidence and risk factors of perioperative respiratory adverse events in children undergoing elective surgery. Paediatr Anaesth. 2004;14(3):218-24.
• Lerman J, Houle TT, Matthews BT, Houck J, Burrows FA. Propofol for tracheal intubation in children anesthetized with sevoflurane: a dose– response study. Paediatr Anaesth. 2009;19(3):218-24.
• Cagiran E, Eyigor C, Balcioglu T, Uyar M. Tracheal intubation in intellectually disabled patients: clinical usefulness of remifentanil and sevoflurane without a muscle relaxant. J Int Med Res. 2013;41(5):1632- 8.
• Joo HS, Perks WJ, Belo SE. Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents. Can J Anaesth. 2001;48(7):646.
• Naziri F, Amiri HA, Rabiee M, Banihashem N, Nejad FM, Shirkhani Z, et al. Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study. Saudi J Anaesth. 2015;9(4):409.
• Batra Y, Al Qattan A, Ali S, Qureshi M, Kuriakose D, Migahed A. Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Paediatr Anaesth. 2004;14(6):452-6.
• Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998;86(1):45-9.
• Solak A TA, Tuncer S, Yosunkaya A, Reisli R, Okesli S. Cocuklarda Propofol ve Remifentanil İleTotal İntravenoz Anestezi Uygulamasının Sevofluranve Azot Protoksit Anestezisi İle Karşılaştırılması. Turk J Anaesthesiol Reanim. 2004;2(3):130-6.
• Ozgultekin A, Turan G, Doğramacı Gy, Celik H, N. A. Cocukların Gunubirlik Anestezisinde Sevofluran, Desfluran ve Propofol- Remifentanil (TIVA) Uygulamalarında Derlenme Ozellikleri. Turk J Anaesthesiol Reanim. 2007;5(2):57-63.
• Claeys MA, Gepts E, Camu F. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth. 1988;60(1):3-9.
• Schaer H. Disoprivan zur Einleitung und Unterhaltung von Kurznarkosen. Der Anaesthesist (Berlin Print). 1986;35(9):531-4.
• Reves J. The entry of remifentanil in to the clinical practice and the topics on education. Anesth Analg 1999;89:4-6.
• Bailey P. Narcotic intravenous anesthesia. Anaesthesia. 1990;1:181- 366.
• Black T, Kay B, Healy T. Reducing the haemodynamic responses to laryngoscopy and intubation: a comparison of alfentanil with fentanyl. Anaesthesia. 1984;39(9):883-7.
• Tramer M, Moore A, McQuay H. Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: propofol anaesthesia vs omitting nitrous oxide vs total iv anaesthesia with propofol. Br J Anaesth. 1997;78(3):256-9.
• Na HS, Song IA, Hwang JW, Do SH, Oh AY. Emergence agitation in children undergoing adenotonsillectomy: a comparison of sevoflurane vs. sevoflurane‐remifentanil administration. Acta Anaesthesiol Scand. 2013;57(1):100-5.
• Wandel C, Neff S, Bohrer H, Browne A, Motsch J, Martin E. Recovery characteristics following anaesthesia with sevoflurane or propofol in adults undergoing out-patient surgery. Eur J Clin Pharmacol. 1995;48(3):185-8. doi: 10.1007/BF00198296.
• Cukurova Z, Eren G, Uludag H, Hergunsel O, Leblebici H, Aslantay M. Comparison of the Effects of Bupivacaine, Mepivacaine and Lidocaine Used Intrathecally in the Ambulatory Surgery of the Lower Abdomen and the Extremities. Turk J Anaesth Reanim. 2007;35(2):90.